The stigma of obesity: a review and update

Impacts of stigma and discrimination on people with obesity who smoke cigarettes

Stigma is the state of social devaluation due to a trait or group identity; weight and smoking-based self-, felt-, and enacted stigma may have detrimental health effects and pose barriers to smoking cessation. This study examined associations between stigma, discrimination, and health for people with overweight or obesity (body mass index [BMI] ≥ 25) who smoke cigarettes (cigarettes smoked/day ≥ 5) who reported interest in quitting smoking and minimizing weight gain. Participants (N = 63; predominantly women (81.0 %), White (63.5 %) or Black/African American (31.7 %), and heterosexual (85.7 %) with 50 % having a yearly income below $50,000) completed the measures of stigma (i.e., Weight Bias Internalization Scale and Internalized Stigma of Smoking Inventory), discrimination (i.e., Everyday Discrimination Scale), and symptoms of depression, weight, smoking, nicotine dependence, and concerns about gaining weight while quitting smoking were measured. Those who reported more internalization of weight bias and more everyday discrimination reported greater depressive symptomatology and greater concern about gaining weight while quitting smoking, with depressive symptomatology fully mediating both internalization of weight bias and everyday discrimination's relation with concern about gaining weight while quitting smoking. There was also an association of smoking felt-stigma, but not self- or enacted-stigma, with symptoms of depression. Stigma's associations with symptoms of depression and post-cessation weight concern suggest barriers to effective behavior change, and interventions may consider targeting processes for coping with stigma experienced by this population.

Understanding Differences in Medical Student Perceptions of Treatment Adherence Based on Weight Status in Pediatric Care

Obesity biases in healthcare are detrimental. We explored medical student beliefs underlying perceptions that child-mother dyads with obesity are less likely to be treatment adherent. Participants viewed scenes of a 12-year-old, female virtual human presenting to a physician with back pain, accompanied by her mother. Patient and mother weight cues were manipulated across scenes. Out of 120, 35 participants perceived dyads with obesity as less adherent to hypothetical pain-related treatment recommendations relative to dyads with healthy weight. These participants were informed and asked why. Responses were analyzed for themes. Fifty-two responses revealed three codes relating to participants' explanation of why they perceived lower adherence for dyads with obesity-obesity is associated with: 1) non-compliance with general health recommendations, 2) internal traits/factors (i.e., mothers' less health consciousness, mental strength), 3) external factors (i.e., lower health literacy, socioeconomic status). The association of obesity with lower adherence is a bias that may exist among medical students and originate from assumptions about prior health adherence and maternal traits, some disparaging in nature. Such bias has potential to contribute to healthcare disparities. Findings highlight the utility of qualitative methods to understand beliefs driving perceptions and design bias-reducing interventions to trainee needs.

Metabolic clues to memory loss: High-fat diets and brain-adipose crosstalk in zebrafish

Obesity is a growing public health concern that significantly impacts cognitive functions, including memory. This research explores how a high-fat diet affects short-term memory, employing the novel object recognition (NOR) test and NMR-based metabolomics to elucidate metabolic alterations in the brain and adipose tissue. The zebrafish were divided into two groups: one receiving a standard diet (SD) and the other a high-fat diet (HFD). Body mass index (BMI) was assessed every two weeks for a period of eight weeks. The NOR test was used to determine the discrimination index (DI) for evaluating the short-term memory of the SD and HFD groups. NMR spectroscopy was employed to investigate the metabolites in brain and adipose tissues, and multivariate data analysis was conducted to discover significant metabolic alterations. The high-fat diet (HFD) resulted in a significant increase in body mass index (BMI) (p < 0.0001) compared to the standard diet (SD) group from week 4 to week 8. A significant reduction in the discrimination index (24.95 %) in the HFD group against the SD group suggests a decline in memory performance among HFD subjects. NMR-based metabolomics of adipose tissue revealed that linoleic acid and caprylic acid were consistently found to exhibit increased levels in the HFD group across all assessments, whereas lauric acid, ALA, EPA, and DHA were consistently present at elevated levels in the adipose tissue of the SD group. NMR-based metabolomics of the brain identified GABA, taurine, and histamine as the key metabolites distinguishing the HFD from the SD group in female zebrafish. For male zebrafish brains, taurine, phenylalanine, and tryptophan were identified as the most significant metabolites for differentiating between HFD and SD. These metabolites demonstrated a notable decrease in the HFD group relative to the SD group. The results of this study align with those of previously reported studies in rodents and humans, indicating that memory impairment associated with obesity may stem from neuroinflammation and changes in synaptic plasticity. This research provides insights into the molecular changes in adipose tissue and the brain that occur when individuals receive a high-fat diet (HFD), which may enhance our understanding of the link between obesity and memory impairment, ultimately leading to a better comprehension of the disease.

Weight self-stigma, but not body dissatisfaction, predicts binge eating across one academic year

Body dissatisfaction is a risk factor for disordered eating behaviors, including binge eating, dietary restriction, and purging. Research indicates weight self-stigma (WSS), the internalization of negative beliefs about one's weight, is an additional risk factor for disordered eating behaviors. We sought to understand the relative contribution of WSS and body dissatisfaction on future disordered eating symptoms (binge eating, purging, dietary restriction) across 1 academic year when included in the same predictive model among a sample of college students [N = 259; 78 % women; 71 % white; Mean (SD) age = 19.21 (1.24) years]. Data were analyzed using three multiple linear regression models. In each, WSS and body dissatisfaction were specified as predictor variables while binge eating, purging, and dietary restriction were entered as outcome variables, adjusting for the relevant ED behavior at baseline. Baseline WSS (p < .001), but not body dissatisfaction (p > .05), predicted 8-month follow-up binge eating. Neither baseline WSS or body dissatisfaction predicted follow-up purging or dietary restriction (ps > .05). Results suggest that WSS is a stronger longitudinal predictor of binge eating than body dissatisfaction when included in the same model. Campus-wide interventions and messaging that address WSS may help reduce the risk of binge eating.

Health-related stigma, perceived social support, and their role in quality of life among women with lipedema

Lipedema is a chronic disease in adipose tissue affecting women. The distinctive body appearance in lipedema, often mistaken for obesity, may be detrimental to social life. In our online cross-sectional survey study, conducted from June to September 2021 among 245 women with lipedema, we found significantly more health-related stigma compared to an aged-matched general female population (N = 1872), leading to an overall lower quality of life. Conversely, strong social support was associated with better social and emotional functioning. As such, healthcare professionals must, even in the early stages, recognize this disease and address its impact on psychosocial health and well-being.

Frequency and Predictors of Shape/Weight Concerns and Objective Binge Eating in Avoidant/Restrictive Food Intake Disorder (ARFID)

OBJECTIVE

DSM-5 prohibits the diagnosis of avoidant/restrictive food intake disorder (ARFID) in the context of clinically significant shape/weight concerns. However, emerging data suggest that ARFID and shape/weight concerns may co-occur, and DSM-5-TR now permits comorbid binge-eating disorder alongside ARFID. We compared shape/weight concerns in adults with ARFID to healthy controls (HCs) and nonclinical norms; assessed the frequency of clinical-level shape/weight concerns and past-month objective binge episodes (OBE); and identified ARFID characteristics linked to elevated shape/weight concerns and OBEs. We hypothesized that individuals with ARFID would exhibit lower shape/weight concerns than HCs and nonclinical norms, that none would exhibit clinical-level shape/weight concerns, and that higher weight would predict greater shape/weight concerns. Our examination of OBEs was exploratory.

METHOD

Participants with ARFID (N = 83) and HCs (N = 41) completed the Eating Disorder Examination-Questionnaire (EDE-Q).

RESULTS

Adults with ARFID scored significantly higher than HCs but significantly lower than nonclinical norms on shape/weight concerns. Two percent exhibited clinical-level shape/weight concerns, and 15% reported past-month OBEs. Higher weight uniquely predicted shape/weight concerns.

DISCUSSION

Shape/weight concerns are lower in ARFID than in the general population, and a small proportion of adults with ARFID-particularly those at higher weights-may experience clinical-level shape/weight concerns and OBEs.

The weight of words: investigating the role of weight stigma and body mass index in shaping children and youth's emotional experiences

BACKGROUND

The prevalence of overweight and obesity among children and adolescents has become a significant public health concern worldwide. These conditions not only affect physical health but also contribute to psychological challenges, particularly through weight stigma. Understanding the relationship between weight stigma, body mass index (BMI), and emotional distress is crucial for informing interventions, particularly in cultural contexts where weight-related perceptions vary.

AIM

This study aimed to investigate the influence of weight stigma and BMI on the emotional experiences of children and youth in Egypt.

METHODS

A descriptive correlational design was employed in 16 preparatory schools, 49 secondary schools, and 20 faculties across various Egyptian governorates. A convenience sample of 2,731 participants aged 12-21 years was included. Data were collected using an online questionnaire that measured BMI, weight stigma, and emotional states (depression, anxiety, and stress) through validated tools. Statistical analyses included chi-square and linear regression tests.

RESULTS

The findings revealed that 22% of participants experienced high levels of weight stigma, which was significantly associated with higher levels of emotional distress (p < 0.001). Weight stigma explained 46.9% of the variance in emotional distress, whereas BMI showed no significant association with emotional states (p = 0.983). Notably, cultural factors, including conflicting societal norms regarding body weight and media influence, appeared to shape weight perceptions and stigma experiences among youth.

CONCLUSION

Weight stigma is a stronger predictor of emotional distress than BMI, emphasizing the need for targeted interventions addressing weight-based discrimination. Given the cultural nuances influencing weight perception in Egypt, public health initiatives should incorporate culturally sensitive approaches to promote body positivity and mitigate the psychological impact of stigma. These findings contribute to global eating disorder research by highlighting the role of sociocultural factors in shaping weight-related experiences among youth.

Ethical considerations in shoulder arthroplasty in patients who are obese

Obesity and osteoarthritis are two of the most common conditions in the United States and often co-occur. Obese patients with osteoarthritis are at increased risk for complications when undergoing total shoulder arthroplasty (TSA). The ethical consideration relevant to the decision to perform TSA in obese and morbidly obese patients who may benefit from surgery is not well understood. We performed an ethical analysis for patients undergoing TSA who are obese by analyzing the 4 core bioethical principles, beneficence, nonmaleficence, autonomy, and justice. To provide the most benefit to patients, counseling patients on weight loss before surgery should be attempted including bariatric surgery or weight loss medication in select patients. To respect the ethical principles of beneficence and nonmaleficence, the surgeon must carefully weigh the potential for debilitating progression of disease, pain, and the psychological toll of osteoarthritis against the concern that obese patients may have a higher risk of complications. Respecting patient autonomy requires a rigorous, standardized consent process, which is informed by an understanding of common cognitive biases that affect patient understanding and minimization of perverse incentives that make it more difficult for the surgeon to spend adequate time and resources counseling the patient. Improving incentives for hospitals and physician alike to treat patients with obesity and other comorbidities will provide most just care while minimizing long-term harmful effects to the patient, surgeon, and health-care system.

An interpretative phenomenological analysis of lived experiences and psychological processes in internalized weight stigma

OBJECTIVE

Internalized weight stigma (IWS) refers to the internalization of societal weight-based prejudices. While research on external weight stigma is well-established, the psychological mechanisms underlying IWS remain underexplored. This study aims to provide a deeper understanding of IWS by examining the lived experiences of individuals with obesity and identifying key psychological processes contributing to IWS.

DESIGN

A qualitative design was employed, using both in-depth interviews and photo-elicitation to explore the lived experiences of nine participants.

METHODS

Participants were invited to take pictures of situations which made them feel stigmatized about their body size during a 2-week-long photography task. Subsequently, participants reflected on the implications of their photographs during a 60-minute research interview. IPA was used to guide the analysis of the interview data.

RESULTS

Four key psychological processes contributing to IWS were identified: (1) Self-application of negative stereotypes, where participants internalized societal stigma, sometimes resisting it but still experiencing self-critical thoughts; (2) Imposition of an undesired identity, where societal labels restricted self-expression, leading participants to adopt socially acceptable personas; (3) Heightened anxiety and social vigilance, where participants experienced anxiety, hyper-awareness, and discomfort in public settings; and (4) Distress and coping, where emotional distress and coping strategies like social withdrawal appeared to reinforce IWS.

CONCLUSIONS

These findings extended existing literature by providing a data-driven conceptualization of IWS. The findings underscore the importance of developing psychological interventions that address both IWS and external societal weight stigma, focusing on strategies that challenge self-critical narratives and promote more adaptive self-concepts.

Weight Stigma in the Development, Maintenance, and Treatment of Eating Disorders: A Case Series Informing Implications for Research and Practice

Weight-centric health practices are based on the principle that excess weight predicts chronic disease, informing a growing sociopolitical movement to address an "obesity epidemic." This hyper-focus on preventing obesity may contribute to weight stigma (i.e., the devaluation and discrimination of individuals based on body size) and other iatrogenic outcomes for youth, including the development and maintenance of eating disorders (EDs). Current evidence-based treatments for EDs include language and practices that may reinforce fears of fatness, body shame, and unhealthy dietary restriction without guidance on addressing weight stigma. Here, we present case examples from three adolescent patients across ED presentations and body sizes to (1) elucidate the role of weight stigma in ED development, (2) highlight the ubiquity and harms of weight stigma within ED treatments, and (3) outline thoughtful protocol adaptations to avoid further harm and facilitate recovery. We conclude with a call for immediate action to advance research characterizing the harms of weight-centric approaches in existing ED interventions to reduce the risk of iatrogenic effects on youth with EDs and advance weight-inclusive approaches to ED treatment.

Social anxiety and weight interact with body salience to affect experiences of social exclusion

BACKGROUND

Individuals at a higher weight experience greater victimization and exclusion by peers, and limited research suggests that the salience of one's body image may increase negative emotional reactions to social rejection. Additionally, social exclusion is related to higher levels of social anxiety (SA). We examined how body salience interacts with SA and weight to predict anxiety, self-esteem, and negative affect following social rejection.

METHODS

Participants were undergraduate women (N = 186). We explored the interactive effects of SA, body mass index (BMI), and body salience (i.e., face versus body photo condition) on emotional response to exclusion in a social ostracism paradigm, Cyberball. BMI and self-reported SA were collected at baseline. One week later, participants played Cyberball and reported state affect, anxiety, and self-esteem before and after the game.

RESULTS

The 3-way interaction of BMI, SA, and photo condition did not significantly predict post-exclusion state measures. Photo condition moderated the relationship between SA and post-exclusion anxiety and between BMI and post-exclusion anxiety.

CONCLUSIONS

Those with higher SA were particularly anxious following exclusion if their bodies were visible to others. Additionally, those with lower BMI experienced greater anxiety after exclusion when their body was visible than those with higher BMI.

Competing Cultural Discourses of GLP-1 Agonists: An Application of Relational Dialectics Theory

As GLP-1 medications become more available and FDA approved in a number of cases, discourses related to their use by individuals for purposes of weight loss and management permeate social life. Prominently, weight management is often positioned in society and researched as a private matter of individual choice, behavior, and responsibility. Relational dialectics theory posits culturally dominant discourses and marginalized discourses to be in constant flux with power as central to meaning construction. Therefore, we examine the competing discourses that animate the weight management experiences of people who have used, have considered using, or are currently using GLP-1 medications to manage their weight through the lens of relational dialectics theory. Through an online, qualitative survey (n = 130) and contrapuntal analysis, we identify four discourses: GLP-1s as a magic bullet and quick fix; deservingness; GLP-1s as freedom and control; and GLP-1s as medically necessary. The interplay of these discourses reveals people using GLP-1 medications for weight management as being doubly stigmatized. As such, they are stigmatized both for their weight and their method of weight management resulting in an inability to escape dominant discourses.

Gender-based analysis of body dissatisfaction among youths in Singapore: findings from the National Youth Mental Health Study

Introduction

Body dissatisfaction, often arising from the disparity between the perceived ideal and actual body, is prevalent among young individuals and is linked to various mental health issues. Previous research consistently indicates notable differences in body dissatisfaction between males and females. This study used data from a nationwide study to determine the prevalence of body dissatisfaction among young individuals in Singapore. It also aims to identify associated sociodemographic, health-related, and psychosocial factors using a gender-based approach.

Methods

Data were obtained from 2600 youths aged 15-35 who participated in the National Youth Mental Health Study. Information on sociodemographic background, body dissatisfaction, childhood trauma, BMI, self-esteem, and social media use was collected. Weighted multiple logistic regressions were performed to identify the sociodemographic variables, as well as other health-related and psychosocial factors associated with body dissatisfaction, stratified by gender.

Results

20.2% (25.7% females; 14.8% males) reported moderate to marked body shape concerns. Among females, younger ages, Indians (vs. Chinese), those with diploma education (vs. university), those with overweight, those with childhood trauma, and those with greater daily social media usage were more likely to report moderate to marked body shape concerns. Among males, those with primary education and below (vs. university), those with overweight, and those with greater daily social media usage were more likely to report moderate to marked body shape concerns.

Discussion

These results emphasize the importance of creating specific public health programs that consider the different experiences and challenges related to body dissatisfaction based on gender. These programs could help promote body image positivity, increase self-compassion, and encourage critical engagement with social media content.

The Impact of Bias and Stigma on Patient Referral for Metabolic/Bariatric Surgery: An Algerian Experience

Obesity is a chronic disease causing a major public health challenge, particularly in Algeria, yet in patient referrals for metabolic/bariatric surgery (MBS), the most effective treatment remain low. This study aims to analyze the factors influencing referrals for MBS, focusing on the impact of obesity bias and stigma among primary care physicians. A survey questionnaire was sent electronically to 250 physicians across four regions in Algeria. The questionnaire evaluated their knowledge, attitudes, perceptions, and practices regarding MBS including questions on indications for MBS, operative techniques, physicians' attitudes toward patients with obesity, and factors influencing patient referrals for MBS. Survey response rate was 37.2% (93/250 physicians), most physicians (89%) recognized obesity as a chronic disease, and majority (60%) of physicians were aware that hunger regulation centers are involuntary and located in the hypothalamus; 34.4% believed that lifestyle changes were sufficient to treat severe obesity. Significant knowledge gaps were observed regarding MBS indications, 83% expressed a willingness to help their patients achieve ideal weight, but only 10% of physicians referred patients for MBS. Many physicians showed negative attitudes toward patients with obesity, and 68% held stereotypes about obesity, attributing it to a lack of personal willpower. These stigmas may have contributed to the low referral rates for MBS. Additional barriers were economic barriers, such as the high cost of MBS and limited or absent insurance coverage. A lack of knowledge about metabolic/bariatric surgery, coupled with stigmatizing attitudes and economic constraints, hinders patient referrals for MBS, which is the most effective treatment for severe obesity. The study highlights the need for more education of primary care physicians, promoting an empathetic and interprofessional approach and implementing health policies that improve financial accessibility to MBS in Algeria.

Overweight, Obesity, and Depression in Multimorbid Older Adults: Prevalence, Diagnostic Agreement, and Associated Factors in Primary Care-Results from a Multicenter Observational Study

Background/Objectives: Obesity and depression, in conjunction with multimorbidity, are interconnected conditions increasingly managed in general practitioner (GP) settings, yet these associations remain insufficiently studied in older patients. This study investigates the prevalence of depression across different body mass index (BMI) classes and includes age and gender differences in multimorbid older patients, offering a novel perspective on subgroup-specific patterns. Further the agreement between GP depression diagnoses and the Geriatric Depression Scale (GDS) is studied and patient-specific factors that may affect the agreement are explored, aiming to improve future diagnostics for vulnerable subgroups. Methods: Data were provided by the baseline assessment of the MultiCare Study, a prospective multicenter observational cohort of multimorbid patients aged 65+ years recruited from 158 GP practices across eight study centers in Germany. Data from 2568 study participants were analyzed based on GP-coded International Classification of Diseases (ICD) diagnoses, structured GP questionnaires, and patient questionnaires. Assessments included data on the BMI and depression (15 item version of the GDS). Agreement between GP diagnoses of depression and GDS assessment was measured using Cohen's kappa. Four logistic regression models were used to examine the effects of patient-specific factors on the agreement of depression diagnosis (match or mismatch). Results: GPs diagnosed depression in 17.3% of cases, compared to the detection of depressive symptoms in 12.4% of the patients by GDS (cut-off ≥ 6 points). The highest prevalence rates were observed in patients with obesity class III (25.0% by GP; 21.7% by GDS). Women were significantly more likely to receive a depression diagnosis by a GP across most BMI classes (except obesity classes II and III). The detection of depressive symptoms by GDS was significantly more prevalent in older multimorbid obese patients (≥75 years), except for patients with obesity class III. The overall agreement between GP diagnosis and GDS assessment was weak (κ = 0.156, p < 0.001). The highest agreement was found for people with obesity class III (κ = 0.256, p < 0.05). Factors associated with a True Positive depression diagnosis (match by both GDS and GP) were female gender (odds ratio (OR) = 1.83, p < 0.05), widowhood (OR = 2.43, p < 0.01), limited daily living skills (OR = 3.14, p < 0.001), and a higher level of education (OR = 2.48, p < 0.01). A significantly lower likelihood of a False Negative depression diagnosis was found for patients with obesity class III. Conclusions: This study highlights the significant prevalence of depression among multimorbid older adults across different BMI classes, particularly in those with obesity class III. The weak diagnostic agreement between GP diagnosis and GDS assessment suggests a need for improved diagnostic practices in primary care. Implementing standardized screening tools and fostering collaboration with mental health specialists could enhance the identification and management of depression in this vulnerable population.

Ecological momentary assessment of weight-related stress predicting eating disorder and affective symptoms

Weight-related stress (e.g., experiencing weight stigmatization) is an important factor that contributes to engagement in maladaptive eating behaviors and increased risk for mood and anxiety disorders. Forty-nine adults that met the criteria for binge-eating disorder and/or food addiction completed baseline questionnaires and a 10-day ecological momentary assessment protocol during which they reported experiences of weight-related stress, binge-eating symptoms, dietary restraint, body satisfaction, and negative affect throughout the day. Generalized linear mixed models were used to examine associations between within- and between-subject weight-related stress and binge-eating symptoms, dietary restraint, body satisfaction, and negative affect. Weight-related stress was not associated with binge-eating symptoms; however, at the within-subjects level, experiencing weight-related stress was associated with lower body satisfaction (p = .008) and elevated dietary restraint and negative affect (ps < .001). At the between-subjects level, weight-related stress was associated with increased negative affect (p = .007). Among adults with binge-eating disorder and/or food addiction, weight-related stress may be a relevant social/intrapersonal experience that impacts individual's momentary affective well-being and restraint. Results suggest the need for public health interventions for reducing systemic societal weight-related stigmatization as well as use of individual intervention strategies focused on reframing negative thoughts associated with weight-related stress to reduce its emotional impact.

The global burden of high BMI among adolescents between 1990 and 2021

BACKGROUND

Adolescent high body mass index (BMI) is a growing global health problem. This study analyzes global, regional, and national prevalence and trends of high BMI among adolescents (aged 10-19 years) from 1990 to 2021, investigates disparities by sex, country, and socio-demographic index (SDI), and projects prevalence to 2030.

METHODS

This study analyzed Global Burden of Disease (GBD) study 2021 data. Prevalence and trends of high BMI among adolescents were stratified by sex, SDI, and region. Estimated annual percentage change (EAPC), joinpoint regression, and Bayesian age-period-cohort (BAPC) analysis were used to quantify trends and project prevalence to 2030.

RESULTS

Global adolescent high BMI prevalence has increased from 8.36% (1990) to 17.64% (2021), with females having a slightly higher prevalence than males. Marked disparities are observed across SDI levels; high SDI countries have the highest prevalence, but middle SDI countries are experiencing the fastest increases. Substantial geographic variations are also evident, with particularly rapid increases in some regions, such as the Pacific Island nations, and slower growth or declines in others, such as parts of East Asia. The BAPC model projects a continued rise in global high BMI prevalence up to 2030, with considerable variation across individual countries.

CONCLUSIONS

The global rise of high BMI among adolescents, coupled with projections of continued increases, presents a pressing public health concern. The observed disparities across SDI levels and geographic regions necessitate tailored interventions to address this growing epidemic effectively.

The relationship between body roundness index (BRI) and suicidal ideation: evidence from NHANES 2013-2018

IMPORTANCE

Emerging research suggests a complex interplay between physical health metrics and mental health outcomes, including suicidal ideation. The body roundness index (BRI), a novel measure of body size, may offer insights into this relationship. This study seeks to investigate the intricate connection between BRI and suicidal ideation in a sample that reflects the entire U.S. population-working to validate the potential of BRI as a predictor of suicidal ideation.

METHODS

Data from the NHANES spanning 2013 to 2018 was used in this cross-sectional study to analyze a sample of 14,058 participants. BRI was calculated based on height and waist circumference measurements. Suicidal ideation was assessed using the Mental Health-Depression Screener Questionnaire ninth question. To investigate potential non-linear relationships between BRI and suicidal ideation, we employed generalized additive models and smooth curve fitting, and used ROC curves to compare the predictive ability of BMI and BRI for suicidal ideation. Subgroup analyses and interaction tests were utilized to study the moderating effects of categorical covariates.

RESULTS

Multiple logistic regression analysis revealed a significant positive correlation between increased BRI and heightened suicidal ideation, with a nonlinear pattern persisting even after adjustment for covariates. This nonlinear relationship was reinforced by a sharp increase in the prevalence of suicidal ideation when the BRI exceeded 6.7. Based on ROC curve analysis, BRI demonstrates a slightly stronger predictive ability for suicide ideation compared to BMI. Subgroup analyses confirmed the relative robustness of this association across populations, including age, education and PRI, etc. However, the interaction between the two was influenced by gender, coronary artery disease and angina pectoris.

CONCLUSION

In conclusion, our cross-sectional study reveals a significant positive correlation between increased BRI and heightened suicidal ideation, with a sharp increase in prevalence when BRI exceeds 6.7. It is recommended that appropriate BRI be maintained to minimize suicidal ideation.

Passing on the flame: Do mega sports events promote health behaviours?

To justify billion-dollar public expenditures on mega sports events, proponents often suggest lasting improvements in health behaviours among the general public. To estimate the returns to health behaviours from hosting the 2012 London Olympics, we collected panel data on more than 19,000 respondents across two European capitals, London and Paris, between 2011 and 2013. Using a difference-in-differences design with Paris as counterfactual, we find an increase in physical activity by six percentage points among the inactive, from a baseline of 34%. Activation, however, lasts only for about 100 days. Although we also find suggestive evidence for reduced alcohol and tobacco consumption during the event, a cost-benefit analysis suggests that staging mega sports events is not a cost-effective policy to promote lasting health behaviour change.

Assessing Weight Stigma Interventions: A Systematic Review of Randomized Controlled Trials

PURPOSE OF REVIEW

The primary goals of this pre-registered systematic review were to critically evaluate the existing randomized controlled trials targeting weight stigma/bias and identify promising avenues for future research.

RECENT FINDINGS

Prior systematic reviews have highlighted intervention strategies such as shifting causal attributions of obesity, evoking empathy, deploying weight-inclusive approaches, increasing education, and combining these strategies. Here, we provide an updated systematic review of weight stigma interventions. A systematic search was conducted following the PRISMA guidelines and performed in PubMed/Medline, PubMed, PsycINFO, and Google Scholar until October 2024, yielding a final sample of 56 articles. In addition to previously established strategies, we identified several novel strategies, such as cognitive dissonance and connection building. Interventions can largely shift attitudinal outcomes, but future research should extend beyond attitude measures, assess weight bias over a longer term, and across more diverse populations.

The association of age of onset of obesity with experienced weight stigma in adulthood

BACKGROUND

Experienced weight stigma (EWS) is linked to adverse physical and mental health outcomes, including maladaptive health behaviors and attenuated weight loss in people with obesity. Limited research is available regarding the association between the age of onset and severity of obesity and lifetime experience of EWS among adults with obesity.

METHODS

Cross-sectional survey data (n = 686) from a single-site academic obesity medicine program was analyzed, including demographics, anthropometric measures, and the Stigmatizing Situations Inventory (SSI-B). The median SSI-B score was used to dichotomize the EWS outcome variable. Crude associations were assessed by chi-square and logistic regression analyses. Multivariable logistic regression determined age-adjusted odds ratios (aOR) of EWS with body mass index (BMI) at age 18 years and peak BMI.

RESULTS

Participants had a mean age of 55.8 years (SD = 12.7), and the majority were female and white. EWS was correlated with BMI at age 18 years (r = 0.38; p = 0.001) and peak BMI (r = 0.48; p = 0.001) before and after adjustment. Those with severe obesity (BMI ≥ 40) by 18 years had 2.79 times higher odds (aOR = 2.79; 95% CI: 1.38, 5.62; p < 0.01) of severe EWS vs. those who developed severe obesity after 18 years; 2.17 higher odds [aOR = 2.17; 95% CI: 1.08, 4.35; p = 0.009] of severe EWS versus those with BMI < 40 at 18 years; 2.98 times higher odds [aOR = 2.98; 95% CI: 1.44, 6.15; p = 0.001] of severe EWS vs. those with BMI < 30 at 18 years; and 4.06 times higher odds [aOR = 4.06; 95% CI: 1.39, 6.73; p = 0.001] of severe EWS vs. those with BMI < 25 at 18 years.

CONCLUSION

Those with severe obesity before the age of 18 years were nearly 3 times more likely to report severe EWS than people who developed severe obesity later in life. Healthcare providers should consider screening for EWS in people with early onset of severe obesity, to identify those who may benefit from weight stigma interventions and support.

Views Among the General Public on New Anti-Obesity Medications and on the Perception of Obesity as a Failure of Willpower

Background

The experience of obesity stigma is associated with negative clinical outcomes that include increased mental health problems and additional weight gain. Researchers have treated the public view that obesity is caused by poor willpower as both an element of obesity stigma and as a cause of obesity stigma. Here we test the hypothesis that awareness of new and effective glucagon-like peptide receptor agonist anti-obesity medications (AOMs) will encourage the view that obesity is a biologically-determined medical condition rather than a personal willpower failure and thereby lessen obesity stigma.

Materials and Methods

Two questionnaire studies, in which participants were randomly assigned to either read about the success of AOMs or to read various alternative material (N = 640 in total), investigated the effect that AOM awareness has on views of obesity.

Results

Contrary to the study hypotheses, reading about AOMs did not increase the degree to which participants viewed obesity as a medical condition, nor did it reduce the role willpower failure was believed to play in obesity. Across conditions, participants reporting more personal success in weight loss without medication indicated greater belief that obesity was amenable to self-control, expressed greater obesity stigma, and held less positive attitudes toward the use of AOMs to manage weight.

Conclusion

Taken together, these two studies provide no evidence that the success of AOMs will, in the short-term, lead to changes in how people view the etiology of obesity or to a reduction in obesity stigma. Correlational data suggest the possibility that blame and stigma associated with obesity may be robustly informed by participants' understanding of their own experiences managing weight.

The Surgeon Athlete? Analysis of the Nutritional Habits of Orthopaedic Surgery Residents

INTRODUCTION

Orthopaedic surgery residency requires physical stamina and mental acuity. Residents work long hours in demanding conditions like those faced by professional athletes. However, surgical residents often neglect their nutritional needs. This investigates dietary habits of orthopaedic surgery residents and explores strategies to improve nutritional status and performance of residents.

METHODS

A prospective survey created by a dietitian focused on performance nutrition was conducted among orthopaedic surgery residents at a large, tertiary, academic surgery residency program. Data were collected on demographics, nutritional habits, and perceptions of dietary practices.

RESULTS

The survey was completed by 30 orthopaedic surgery residents (19 M and 11 F; 29.8 ± 2.5 years). This cohort had inconsistent nutritional habits, characterized by irregular meal patterns, and frequently skipped meals. The most common barrier revolved around time constraints. Other barriers included stress/emotional eating and undesired weight changes. Male and female residents had similar demographics and outcomes, except that female residents more frequently reported having the highest energy level. Those who skipped meals had lower reported levels of nutritional knowledge and cited limited time to prepare or eat food compared with those who did not.

CONCLUSION

This study underscores the paradox of the "surgeon athlete," where despite facing physical demands like athletes, orthopaedic surgeons fail to prioritize their nutrition. This neglect can impair both performance and long-term health and may trickle down to worse patient care and outcomes. Addressing these issues requires a multifaceted approach. Institutional support is essential to improve access to healthy foods, nutrition education, and fostering a culture that values physician well being.

Utilising a modified accelerated Delphi process to develop a national multidisciplinary consensus on peri-operative optimisation of patients with obesity undergoing non-bariatric surgery

BACKGROUND

In the last three decades, the worldwide prevalence of obesity has increased by threefold. Using a modified Delphi consensus technique, the Irish Surgical Research Collaborative (ISRC) aimed to formulate consensus guidelines on the peri-operative optimisation of patients with obesity undergoing non-bariatric surgery.

METHODS

Subgroups within the ISRC were established to formulate consensus statements using a nominal group technique (NGT) to address the three domains of pre-operative, intra-operative and post-operative care. Three Delphi rounds were circulated nationally to multidisciplinary members of the peri-operative team via electronic survey. Consensus was considered achieved for any statement with >80 % agreement. Data was analysed using Microsoft Excel (Microsoft Corp, Redmond, WA).

RESULTS

Following three Delphi rounds, a total of 94 statements centred around optimising peri-operative care for patients with obesity undergoing non-bariatric surgery reached consensus. Pre-operatively, access to prehabilitation, use of pre-operative risk stratification tools and strategies to reduce obesity-related co-morbidities were all deemed important along with nomination of a hospital obesity lead. Intra-operatively, the prioritised domains were involvement of consultant anaesthetist and surgeon for safe and considered patient positioning, utilisation of minimally invasive surgical techniques, adherence to venous thromboembolism prophylaxis and surgical site infection prevention strategies as well as adoption of multimodal analgesia. Appropriate analgesia prescription, nutritional support, enhanced recovery after surgery and the role of physiotherapy were all deemed essential elements of post-operative care.

CONCLUSION

As a multidisciplinary peri-operative group, through Delphi consensus, we report agreed perioperative standards to optimise the perioperative care of patients with obesity undergoing non-bariatric surgery. This consensus can be utilised to standardise clinical practice and identify areas for quality improvement.

Weight-Inclusive Physical Activity: A Systematic Evaluation of Virtual Resources

BACKGROUND

Higher-weight individuals report lower rates of physical activity behavior and poorer physical activity experiences compared with their normative-weight counterparts, likely owing to the pervasiveness of weight stigma in physical activity contexts. Employing weight-inclusive strategies may improve physical activity outcomes, though little is known about the practical application of weight-inclusive principles in physical activity contexts. Furthermore, given the prominence of virtual methods of information dissemination, exploring online weight-inclusive resources is valuable.

METHODS

Using Google, Instagram, and snowball searches, a virtual environmental scan was conducted to collect publicly available weight-inclusive physical activity resources. Two independent coders applied an a priori codebook to all eligible resources to evaluate the application of weight-inclusive principles.

RESULTS

N = 80 weight-inclusive physical activity resources were identified, offering a range of educational materials (40%) and/or provision of physical activity services (76.3%). Virtual resources generally adhered to weight-inclusive principles by showcasing diversity in body size, using weight-inclusive language, and centering physical activity that honors the body's signals and cues; however, some also included weight-normative content. Provisional physical activity resources primarily targeted diverse-bodied end users, offered a range of physical activity types (eg, yoga, weight training, and dance), were membership-based, and offered asynchronous access.

CONCLUSIONS

This study utilizes a systematic approach to collect and evaluate virtual, publicly available, and weight-inclusive physical activity resources. Virtual physical activity resources that adhere to weight-inclusive principles may be important for increasing accessible physical activity opportunities for higher-weight individuals.

Weight Stigma's Effects on Misdiagnosis of Eating Disorders Among Laypeople and Healthcare Professionals

OBJECTIVE

There is limited research on weight bias in diagnosing eating disorders (EDs), particularly among healthcare professionals (HCPs). This is especially true for atypical anorexia nervosa, a diagnosis recently described in the DSM that includes people with anorexia nervosa symptoms who are not clinically underweight.

METHOD

Using a within-subjects design, we assessed diagnosis, diagnostic confidence, and ED-related medical knowledge among a sample of lay people and medical professionals. Participants read three clinical vignettes (counterbalanced to avoid order effects) of a woman with anorexia nervosa or atypical anorexia nervosa (described as obese) and were assessed on weight stigma and prior ED medical knowledge.

RESULTS

Both lay people and HCPs were less likely to diagnose atypical anorexia nervosa and were less confident in that diagnosis than in the anorexia nervosa vignette condition. Lay participants' diagnostic bias, but not HCPs', was impacted by weight stigma; HCPs' confidence was impacted by weight stigma. In both cases, participants high in weight stigma were more accurate (lay sample) or more confident (HCPs) in diagnoses. Last, greater ED medical knowledge improved accuracy of diagnosis of vignette cases for the HCP sample that included snowball sample recruitment and CloudResearch participants and lay people, but not for the HCP sample recruited via snowball sampling only.

DISCUSSION

These findings highlight the urgency for more public awareness and training for HCPs emphasizing that people of all sizes can present with restrictive eating disorders.

Examining the Psychological Mechanisms Underlying Nostalgia Appeals: A Comparative Experiment of Nostalgia and Regret

Obesity rates remain high among U.S. adults, especially rural residents. Research has shown that nostalgia appeals effectively promote several healthy behaviors. However, the psychological mechanisms underlying nostalgia appeals remain unclear. This study examined the effects of nostalgia appeals on intention to increase exercise and shed light on how nostalgia affected persuasive outcomes. We anticipated that nostalgia appeals would persuade people by enhancing self-esteem and reducing anger and counterarguing. To illuminate the mechanisms underlying the effects of nostalgia, a between-subject experiment (nostalgia appeal vs. regret appeal vs. irrelevant message vs. neutral persuasive message) was conducted among overweight or obese rural Michiganders (N = 507). Results showed that relative to the regret appeal, the nostalgia appeal led to higher state self-esteem, less anger, and less counterarguing. There was no significant difference in attitude or behavioral intention between the nostalgia appeal, regret appeal, and neutral persuasive message. We demonstrated that enhancing self-esteem was the key mechanism by which the nostalgia appeal persuaded the target audience.

Improving obesity management: Insights from the ACTION Switzerland survey of people with obesity, physicians and dietitians

ACTION Switzerland (NCT05232786) examined obesity-related perceptions, attitudes, behaviours and potential barriers to treatment among people with obesity (PwO) and healthcare professionals (HCPs). In March/April 2022, adult PwO (body mass index ≥30 kg/m2, per self-reported height/weight) and physicians/certified dietitians who manage PwO in Switzerland completed online surveys in a cross-sectional design. Overall, 1002 PwO, 125 physicians and 25 dietitians completed the survey. Most physicians (97%) and dietitians (100%), but only 57% of PwO, recognized obesity as a chronic disease. Only 42% of PwO considered themselves to have obesity/extreme obesity, while 61% who had discussed weight with an HCP reported receiving an obesity diagnosis. Many PwO (76%) believed weight loss was entirely their responsibility; physicians were less likely than dietitians to agree it was completely their patients' responsibility (28% vs. 68%). Physicians and dietitians report primarily initiating conversations about weight when patients have obesity-related comorbidities (85% and 64%); their top reasons for not discussing obesity were patients' perceived lack of motivation (76% and 60%) or interest (72% and 64%) in losing weight. In conclusion, some PwO are not aware that obesity is a chronic disease and incorrectly assume complete responsibility for weight loss. Improved communication between PwO and HCPs is required.

"Binge eating disorder is the slum of eating disorders": a qualitative study of Norwegian women with binge eating disorder in the encounter with the healthcare system

BACKGROUND

Binge Eating Disorder (BED) is the most prevalent eating disorder, yet it remains under-recognized and insufficiently understood in both healthcare and society. This leads to a lack of appropriate treatment options and challenges of identification within somatic healthcare. Our study aims to elucidate effective treatment approaches for BED by exploring patients' personal understandings of their treatment needs.

METHODS

We interviewed 6 individuals diagnosed with BED regarding their healthcare experiences and analyzed the data using a modified qualitative method combining thematic and interpretive phenomenological analysis.

RESULTS

The analysis resulted in three main themes: Lack of understanding, Trapped in body shame and Hope and movement, each with belonging subcategories. These themes narrate a journey from being unrecognized with a psychological issue, feeling immobilized by body shame towards embarking on recovery. Particularly Trapped in body shame links the other main themes representing a barrier and a pivotal point in the recovery process.

CONCLUSIONS

Our study highlights that shame related to binge eating and body image is pervasive in participants, exacerbated by a healthcare system that often prioritizes weight and lifestyle. Such shame can block treatment access and prolong the disorder. We argue for a paradigm shift in clinical practice towards patient-centered care that prioritizes empathy and holistic support over weight-focused models. Group therapy can be beneficial in reducing shame, if the group composition is carefully considered. Effective BED treatment should involve creating a safe environment for discussing body shame, emphasizing the need to address this issue to improve treatment effectiveness and patient satisfaction.

Does size matter? Weight bias, stigma, and medical radiation technology practice in Canada

INTRODUCTION

Although biases are a natural part of the human experience, left unchecked, they can lead to considerable harm in the context of healthcare. Weight Bias and Stigma (WBS) is a pervasive bias rooted in the negative attitudes and perceptions of individuals in large bodies. WBS can result in poor health outcomes of large-bodied patients due to weight distraction, delaying or avoiding seeking care, and the presumption of non-compliance. As high-volume carers, Medical Radiation Technologists (MRTs)/Radiographers are a central pillar in the healthcare system; responsible for caring for a multitude of patient populations. The purpose of this study was to explore MRTs perceptions and attitudes regarding large-bodied patients, and to identify subsequent practice implications and areas for improvement.

METHOD

The study included ten practicing MRTs with a range of clinical experience from hospitals across Ontario, Canada. Data were collected using semi-structured interviews (pilot tested) conducted in person and online and analyzed using Braun and Clark's approach to thematic analysis.

RESULTS

Four main themes were identified by analyzing the interview responses including hospital resources, patient care, attitudes and perspectives, and education for future practice. Deficit language and responses provided evidence of WBS not only in the sample population but also within hospitals across Ontario, Canada, as revealed by recounts of stories and comments made by other healthcare professionals. Evidence of empathy and advocacy for large-bodied patients was also found.

CONCLUSION

WBS influences the provision of care in medical radiation sciences. This study found both implicit and explicit WBS, as well as demonstrations of empathy and compassion for large-bodied patients. The emergent themes identified in this study demonstrate the need for improvement in hospital resources and equipment, as well as improvements in education and training of MRTs and other healthcare professionals working with large-bodied patients.

Association between cardiometabolic index (CMI) and suicidal ideation: A cross-sectional analysis of NHANES 2005 to 2018 data

With suicide ranking as a leading cause of death globally, identifying modifiable risk factors is crucial. Suicidal ideation (SI) is a significant precursor to suicide, and there is a growing interest in the role of cardiometabolic factors, particularly the cardiometabolic index (CMI), multiplying the triglyceride-to-high-density lipoprotein cholesterol ratio by the waist-to-height ratio, in mental health outcomes. Previous studies have shown a notable relationship among lipid abnormalities, elevated triglyceride levels, and depressive symptom severity, including SI. This research investigated the correlation between the CMI levels of adult Americans and SI, utilizing data from the National Health and Nutrition Examination Survey (NHANES) ranging from the years 2005 to 2018. After collecting data on demographics, physical examinations, and laboratory testing, multivariate logistic regression analysis was conducted to assess the relationship between CMI and SI while adjusting for relevant factors. The study, which enrolled 15,849 individuals exhibiting symptoms of SI, constituting 3.47% of the total, revealed a significant association between CMI levels and SI. A significant positive association was found between CMI and SI (adjusted OR = 1.07, 95% CI: 1.02-1.13, P = .0029). Moreover, a nonlinear relationship was identified between CMI and SI, characterized by an atypical inverted U-shaped curve with a breakpoint at approximately CMI = 2.08. Subgroup analysis revealed consistent findings across various demographic and clinical subpopulations. The findings of this study demonstrate a substantial correlation between elevated CMI levels and an increased incidence of SI within the US population. Early interventions targeted at individuals with elevated CMI levels, such as psychological support or lifestyle adjustments, may mitigate the risk of SI.

Weight discrimination partially mediates the longitudinal relationship between Body Mass Index and pain

Pain is common among individuals with high Body Mass Index (BMI). This study investigated weight discrimination as a mediator of the longitudinal relationship between BMI and the presence of moderate/severe pain among adults from the English Longitudinal Study of Ageing (ELSA) cohort. ELSA is a longitudinal study of middle-aged and older adults living in England. Data were taken from three consecutive waves. Demographics, BMI, and self-reported pain were collected at wave 4 (2008-2009), perceived weight discrimination at wave 5 (2010-2011,) and pain (no/mild vs moderate/severe) at wave 6 (2012-2013). Generalized linear models estimated the association of BMI at wave 4 (assessed continuously and dichotomized to obesity status BMI ≥30) with pain at wave 6, and weight discrimination at wave 5 as a mediator of this relationship. Models were adjusted for demographics and baseline pain. Complete data were available for n=5362 individuals. Continuous BMI was associated with future moderate/severe pain (b=1.05 SE=0.01, p<.01) and weight discrimination partially mediated this effect (b=1.00 SE=0.002, p=.05). Obesity status was also significant (b=1.43 SE=0.11, p<.01) but weight discrimination did not mediate the relationship (p=.13). Post hoc analyses were conducted among individuals with no/mild pain at baseline (n=3979.) BMI and obesity status were both associated with pain and weight discrimination mediated both pathways (ps<.05.) Weight discrimination partially mediated the relationship between BMI and future moderate/severe pain, especially among individuals with no/mild pain initially. Weight discrimination may be an overlooked contributor to the transition to more severe pain among individuals of higher body weight. PERSPECTIVE: Weight discrimination may be an overlooked contributor to pain among individuals of higher body weight, particularly transition from lower to higher impact states. Post hoc analyses indicate the effect may be specific, as other forms of discrimination did not mediate the relationship.

The arabic version of the fat phobia scale-short form: reliability and structural validity

BACKGROUND

Weight bias, often known as fat phobia or weight stigma, refers to unfavorable attitudes and stereotypes that are associated with, and applied to, larger bodies. Fat phobia can include an unreasonable and abnormal dread of being overweight or being associated with obese people. Currently, there is no validated tool available to measure fat phobia in Arabic. Measuring fat phobia in Arabic-speaking populations is crucial, because cultural attitudes toward body weight can be quite negative and discriminatory; these negative attitudes can negatively impact mental health. The current study aimed to adapt, translate, and assess the structural validity of the Fat Phobia Scale-Short Form (F-Scale 14) in Arabic.

METHODS

The gold standard approach to translation was used. Forward translation involved translation from the English language to the Arabic language by independent translators. Subsequently, a back-translation review was performed on the translated Arabic version for comparison with the original language. A cross-sectional study was conducted online that included 1246 participants from 22 Arabic countries, of whom 74% were female, 66% single, 83% university graduates, with a mean age of 35 ± 6 years.

RESULTS

The F-Scale 14 demonstrated good reliability in the Arabic language, with a Cronbach's α of 0.82 (95% CI 0.80-0.83), comparable to the original scale. The test-retest reliability of the scale was 0.92 (95% CI 0.90-0.94). According to the fit indices, the F-Scale 14 demonstrated a satisfactory level of structural validity in Arab cultures. Fit indices are statistical measures used in confirmatory factor analysis (CFA) to assess how well a proposed model fits the observed data. The scale showed a small improvement in factorial structure after the removal of some items. The two items removed were self-indulgent versus self-sacrificing and disliking food versus likes food. The correlation between F-Scale 14 and the figure rating scale was r = 0.76 (p < 0.001), suggesting adequate convergent validity.

CONCLUSIONS

The F-Scale 14 is a crucial indicator of attitudes and opinions concerning obese or overweight individuals. Based on increased internal consistency reliability and the problematic cultural relevance of two items, we recommend adopting a 12-item version of the scale for better cultural relevance in Arabic populations. It is anticipated that the Arabic F-Scale-12 will be highly useful for research and clinical purposes. Future research should test and adapt the Fat Phobia Scale for diverse Arabic populations to ensure its cultural relevance. Exploring its application in clinical settings will enhance our understanding of weight stigma and inform targeted interventions that promote body positivity. By addressing these areas, we can develop effective strategies to foster healthier attitudes toward body image in Arabic communities.

LEVEL V

Evidence obtained from a cross-sectional descriptive study.

Weight bias among students and employees in university settings: an exploratory study

BACKGROUND

Weight bias and stigmatization are highly prevalent in modern society, especially in educational settings, such as universities. Despite extensive documentation of the adverse consequences on students' daily functioning and psychological health, there is limited literature regarding factors associated with weight bias and its extent in Quebec universities.

OBJECTIVES

This exploratory study aims to assess the prevalence of weight bias and experiences of weight-related stigmatization, as well as to examine their associations with gender, psychological health problems, and status (students or employees) in a college environment in the province of Quebec.

METHODS

Participants were recruited via their university emails. A total of 292 students and 129 university employees participated in an online survey distributed via the secure REDCap platform. The following data was collected: sociodemographic information, status (students or employees), body weight, experiences of stigma, and prejudice towards people living with a higher weight (Fat Phobia Scale; FPS).

RESULTS

Approximately half of the respondents reported experiencing weight-related stigma (44.7%), and half indicated holding prejudice towards overweight people (51.1%), with a moderate rate of bias according to the FPS (3.25). Experience of weight-related stigma was found to be associated with gender (X2 = 7.88, p = 0.019), and a higher prevalence of psychological health problems (X2 = 9.41, p = 0.002), while having prejudice was associated with gender, with men scoring higher at the FPS (F = 7.64, p = 0.006), but not with the status (student or employee). The regression model identified significant effects of status [F(4, 347) = 2.856, p = 0.005] and the interaction between gender and status [F(4, 347) = -2.326, p = 0.021] on the FPS scores.

CONCLUSIONS

Various factors are associated with the experience of weight bias and stigmatization towards people with higher weight in the college population. Campaigns to prevent and reduce weight-related bias should be aimed specifically at staff members as well as students. Future research should examine weight bias internalization as a mediator between self-perceived weight and prejudice.

Obesity as a Disease: A Primer on Clinical and Physiological Insights

Obesity is now recognized as a multifaceted chronic disease that is intricately linked to metabolic, biochemical, and psychosocial dysfunction. In this article, we review the epidemiology of obesity, current understanding of its physiopathology, and the recommended staging system used to approach it as a chronic disease, and we include an overview of its health implications.

Medical management of obesity: unlocking the potential

After a long and challenging history, there have finally been major breakthroughs in the development of effective obesity medications. Agents that act at receptors of one or more gut hormones are achieving unprecedented weight reductions and improvements in cardiovascular risk factors, comparable to some bariatric surgical procedures. Importantly, there is evidence of beneficial effects on a growing range of conditions, including type 2 diabetes, fatty liver, chronic kidney disease, obstructive sleep apnea and cardiovascular disease. Barriers to access need to be overcome to allow the standard of care for obesity to match that of other chronic diseases.

Internalized Shame in Treatment-Seeking Adults with Obesity Class II-III and Its Association with Quality of Life, Body Image, and Self-Esteem

INTRODUCTION

Health-related quality of life (HRQoL) may be impaired in individuals living with obesity, possibly due to exposure to obesity-related stigma which may in turn activate shame. Few studies have been conducted on shame in relation to obesity and its potential association with other constructs such as HRQoL, self-esteem, and body image. In this study, internalized shame and the potential association with HRQoL, self-esteem, and body image were investigated in treatment-seeking patients with obesity class II-III.

METHODS

In total, 228 patients referred for obesity treatment at a tertiary clinic in Sweden participated in the study. The cohort was stratified into two groups using a clinical cutoff (≥50) indicating pathological levels of shame as reported on the Internalized Shame Scale (ISS): a high shame group (HSG) and low shame group (LSG).

RESULTS

The mean ISS score for the overall cohort was 41.6, with a mean of 28.1 for the LSG and 66.5 for the HSG. Compared to the LSG, the HSG reported a lower quality of life in seven of eight HRQoL domains as well as a lower obesity-specific health-related quality of life. Furthermore, a higher shame score was associated with poorer body image and lower self-esteem.

CONCLUSION

Taken together, these findings indicate that a substantial number of patients with obesity report high internalized shame and that these individuals could benefit from extra support in treatment settings.

Exploring body mass index and gender-based self-esteem differences in Saudi Arabia

Background

Self-esteem (SE) and obesity have been associated in various studies. This study investigates this relationship among adults in Saudi Arabia. The objectives of this study are to investigate the relationships between SE and body mass index (BMI) and to examine the interactions between sociodemographic-related factors.

Methods

We designed a cross-sectional study using an online survey that included sociodemographics, a BMI measure, and the Rosenberg Self-Esteem Scale.

Results

Levels of SE did not change substantially between the various age groups, as indicated by the Chi-Square test X2 (12, N = 332, = 5.278, p-value = 0.948). The results for males reveal that there is a variation in the levels of SE across the different BMI categories. This suggests that the BMI categories have a major influence on the levels of SE among males. In both genders, the results indicate a negative association between variables, with a higher BMI being associated with a lower level of SE. The significance of this association stands for both genders (p-value <0.001). For males, the association has a greater influence (Estimate = -0.110, p-value <0.001) than it does for females (Estimate = -0.099, p-value <0.001). In females, the negative link is larger for education (-0.273) and highly impactful (p-value <0.001) in comparison to men (Estimate = -0.157, p-value <0.001). Higher education levels are associated with a lower BMI (p-value = 0.018). For men, the indirect effects show that education (Estimate = 0.0173*) and marital status (Estimate = -0.0405*) significantly influence SE, with other factors mediating these effects. Both genders experience significant and detrimental impacts from BMI on SE, with males experiencing a more pronounced impact. There are considerable disparities in the ways in which these parameters impact SE in both genders, as revealed by the comparisons of the nested models.

Conclusion

There is a negative correlation between BMI and SE in both genders, with a more pronounced impact in men. Gender-specific differences in the relationship between BMI and SE underscore the importance of considering distinct pathways for males and females in future analyses.

Weight discrimination as a predictor of stress and eating: The role of identifying as "fat"

Weight discrimination is associated with deleterious health outcomes, including high stress and disordered eating. According to the rejection-identification model, people who perceive such group-based discrimination respond by identifying more strongly with their stigmatized group, which can attenuate negative consequences of discrimination. However, some research shows that these protective benefits may not exist in the weight domain. Here, we examined whether perceived weight discrimination predicts identifying as "fat," and whether that increased identification protects against negative consequences of discrimination for health. In a larger study, U.S. adults who reported considering themselves "to be overweight" (N = 1725) reported on their perceived weight-based discrimination, fat-group identification, stress, and eating behaviors (i.e., uncontrolled eating, emotional eating, and restrained eating). We tested whether fat-group identification mediated the associations of perceived discrimination to stress and eating. Results showed that perceiving weight discrimination was associated with greater fat-group identification, which in turn was associated with more stress, uncontrolled eating, and emotional eating. These findings suggest that identifying as "fat" in the face of weight discrimination may not reduce subsequent stress or unhealthy eating patterns. As such, in contrast to prior research on the rejection-identification model that suggests identifying with one's group is protective for other identities, "fat" as an identity may not provide the same psychological and physical health benefits.

How experiences of weight stigma impact higher-weight women during their maternity care: A meta-ethnography

AIM

The aim of this review was to explore the experiences of pregnant women and birthing people with higher weight bodies, to understand the extent to which weight stigma impacted their maternity care.

METHODS

We performed a systematic search of seven databases (CINAHL plus, Medline, Social Sciences Full Text [SSFT], International Bibliography of Social Sciences [IBSS], PsychINFO, Maternity and Infant Care [MIC], NIHR Journals Library, EThOS) using the Setting, Perspective, Intervention, Comparison, Evaluation (SPICE) framework search strategy and pre-defined inclusion and exclusion criteria. Included studies underwent a critical appraisal and data richness assessment. We undertook thematic analysis after coding first- and second-order constructs and developed a synthesis from the themes.

FINDINGS

Thirty-eight papers, including six doctoral theses and one book chapter, met the inclusion criteria. Five themes were identified through thematic analysis, and the synthesis demonstrated that women of a higher weight experience shame, harmful attitudes and preconceptions from healthcare professionals regularly and repeatedly while receiving maternity care. This can be alleviated by individualised supportive care from a healthcare professional.

KEY CONCLUSIONS

Negative interactions with maternity care professionals are central to the experience of weight stigma, leading to a sense of 'shame', with pervasive feelings of humiliation, judgement and blame. Current guidance does not acknowledge the stigmatising effects of weight related conversations, additional interventions and restrictions on women's birthplace choices. Adopting a shame-sensitive lens within a culturally safe approach to maternity care could transform support for women.

Dietitians' perspectives on key components relevant for successful dietetic treatment of adults with obesity in primary health care: a qualitative study in the Netherlands

BACKGROUND

Dietetic treatment of adults with obesity can result in effective weight loss with health improvements. However, it remains unclear which components of dietetic consultation are key for successful treatment of individual patients. Therefore, the aim of this study is to explore dietitians' perceptions of key components relevant for successful dietetic treatment of adults with obesity in primary health care in the Netherlands.

METHODS

In this phenomenological study, semistructured interviews were conducted with 18 dietitians who have experience in treating adults with obesity in primary care. Validation of interview data was performed through two focus group discussions with 14 dietitians. Thematic analysis was used to analyse the data.

RESULTS

Four main themes were identified: (i) building a good relationship; (ii) identifying patient needs; (iii) supporting behaviour change and (iv) providing advice. Dietitians highlighted the relevance of building a good relationship with their patients and emphasised adopting a counselling role alongside their role of educator. They also recommended the use of educational materials, counselling techniques and behaviour change strategies (e.g. goal setting, self-monitoring, addressing barriers) to address specific patient needs, such as health literacy, self-efficacy and motivation.

CONCLUSIONS

This study demonstrates that dietitians perceive the ability to build a trusted relationship, in which patient needs are properly explored and addressed, as the key to successful dietetic treatment of adults with obesity. Our findings emphasise the importance of the dietitian's approach in this process and show that patient factors influence the choice of appropriate treatment approaches.

Investigating the associations between a dual diagnosis of malnutrition and obesity and length of stay, readmissions, and 12-month mortality in patients aged >65 yrs admitted to hospital - A retrospective observational single-centre study

OBJECTIVE

Despite the protective effect of obesity on mortality in older patients, the dual diagnosis of obesity and malnutrition may worsen outcomes. This study aimed to investigate whether obese patients aged 65 years and over with a diagnosis of malnutrition have different outcomes to obese, non-malnourished peers.

METHODS

This retrospective study of inpatients included 9 years of data from annual Malnutrition Audits (2011-2019). Obesity was defined as Body Mass Index (BMI) > 30 kg/m2; malnutrition was defined by Subjective Global Assessment (SGA) category B or C. Logistic regression analyses were used to consider the association between a concurrent diagnosis of malnutrition and obesity and outcomes including: 12-month mortality, prolonged length of stay (defined as >50th centile, very prolonged as >75th centile) and hospital readmission within 12 months.

RESULTS

326 obese patients aged 65 years and over were included. Median patient age was 76.1 years, with 51.8 % female. 37 patients (11 %) were malnourished and obese, with a median BMI of 32.9 kg/m2. Malnutrition increased the odds of prolonged length of stay (OR:3.30, 95 % CI 1.58-6.91, p = 0.002) and very prolonged length of stay (OR: 4.17, 95 % CI 1.89-9.21, p = <0.001), as well as increased 12-month mortality (OR: 2.89, 95 % CI 1.40-5.96, p = 0.004). Malnutrition was not associated with increased hospital presentations within 12 months (p = 0.531).

CONCLUSION

Older patients with a dual diagnosis of obesity and malnutrition have worse outcomes than their obese but non-malnourished peers. The presence of obesity should not preclude the assessment of nutritional status in older patients.

Are Instagram Gym Advertisements Working Out? An Experimental Study of Model Body-Size and Slogan-Type

Previous health communication research has demonstrated the negative psychological and health effects of depicting thin-sized models in mass media advertisements including on social media sites such as Instagram. However, gym advertisements are one common source for the presentation of lean and thin-sized models on Instagram. Therefore, the current study guided by social comparison theory and signaling theory aimed to experimentally examine the effect of thin-sized models relative to plus-sized models as well as slogan-type (health and wellness versus physique-based) on women's appearance comparison, body satisfaction, perceived gym fit, and intentions to join the gym. A sample of 217 undergraduate students who identified as women were randomly assigned to one of four Instagram gym advertisement conditions varying in model body-size and slogan-type. Appearance comparisons, perceived gym fit, and intentions to join the gym were measured post advertisement exposure and body satisfaction was measured pre-and-post advertisement exposure. As expected, exposure to Instagram gym advertisements featuring thin-sized models resulted in greater appearance comparisons and lower body satisfaction than exposure to Instagram gym advertisements featuring plus-sized models. Moreover, the combination of plus-sized models with health and wellness slogans in Instagram gym advertisements resulted in greater gym fit perceptions although there was no effect of model body-size and slogan-type on intentions to join the gym. This study supports social comparison theory, signaling theory, and practically the findings indicate that Instagram gym advertisements that depict plus-sized models (versus thin) with health-and-wellness slogans (versus physique) generate fewer body image concerns and lead to greater gym fit perceptions.

Development of the Migraine-Related Stigma (MiRS) Questionnaire: Results of the OVERCOME (US) Study

BACKGROUND

Stigma is emerging as an important social contributor to migraine-related disability and other outcomes. Currently, there are no published validated measures of migraine-specific measures of stigma.

OBJECTIVES

This secondary post hoc analysis of a cross-sectional cohort study aimed to develop a questionnaire to evaluate migraine-related stigma.

METHODS

Based on focus group discussions among persons with migraine and literature review, a panel of migraine experts iteratively developed 12 candidate items for the migraine-related stigma (MiRS) questionnaire, which aims to measure if and how people living with migraine perceive they are viewed in a stigmatizing manner by others. The United States ObserVational survey of the Epidemiology tReatment and Care Of MigrainE (OVERCOME) study identified people with active migraine within a demographically representative United States (US) adult sample and administered the novel MiRS questionnaire in addition to questionnaires assessing sociodemographics, monthly headache days, and migraine disability score (Migraine Disability Assessment) among other data. Exploratory factor analysis was then utilized to evaluate the structure of the MiRS items and determine the Cronbach's alpha described internal consistency of the factors.

RESULTS

This exploratory factor analysis was a secondary post hoc analysis of a cross-sectional cohort study derived from the OVERCOME population-based web survey, which was conducted in a United States sample of 61,932 adults with migraine. The mean (standard deviation) age was 41.7 (14.8) years, 74.5% (n = 46,122) were female, and 70.3% (n = 43,564) identified as White. Two factors were identified: MiRS-external perception of Secondary Gain (eigenvalue = 21.5, percentage of total variance = 88.9%) and MiRS-external perception of Minimizing Burden of migraine (eigenvalue = 2.7, percentage of total variance = 11.1%). The two factors were correlated (r = 0.66) and a non-orthogonal varimax rotation showed that eight items loaded onto the MiRS-Secondary Gain factor, and four items loaded onto the MiRS-Minimizing Burden factor.

CONCLUSION

This population-based study of >60,000 people with migraine allowed the development and validation of the first migraine-specific measure of perceived external stigma for people with migraine. This study demonstrated that MiRS consists of two internally consistent subscales: Secondary Gain and Minimizing Burden. This may be a useful tool for quantifying perceived migraine-related stigma to understand determinants of migraine-related stigma and test interventions to reduce perceived migraine-related stigma.

Justification of Body Mass Index cutoffs for hip and knee joint arthroplasty among California orthopedic surgeons

BACKGROUND

Many orthopedic surgeons choose not to perform joint arthroplasty on patients with a Body Mass Index (BMI) of 35 or above, citing poorer outcomes and increased procedure risk. Identifying and addressing factors surgeons use to determine procedure BMI cutoffs are necessary to increase access to orthopaedic care for this growing patient population. This will help reduce healthcare disparities while also identifying clinical facilities, equipment, training, and procedures that require improvements to accommodate larger individuals.

METHODS

Orthopaedic surgeons were surveyed to identify surgeon-specific BMI cutoffs for hip and knee arthroplasty. The survey was circulated within the California Orthopaedic Association (COA) report during March 2023. Questions aimed to identify BMI cutoffs and justifications such as infection risk, co-morbidities, inadequate equipment, and the American Academy of Orthopaedic Surgeons (AAOS) guidelines. Data on decision making about BMI cutoffs and exceptions were also collected.

RESULTS

75% of respondents use BMI cutoffs for hip and knee arthroplasty. 91% of respondents indicated they are either wholly or partially responsible for setting procedure BMI cutoffs. Mean hip and knee arthroplasty BMI cutoffs were 40.5 and 41, respectively. Four categories for BMI cutoff justifications were identified: (1) risk of complications; (2) surgery logistics; (3) concerns about facilities or resources; and (4) surgeon perception.

CONCLUSIONS

BMI-based justifications for denial of care define key addressable areas of improvement that can increase access to care for life-changing orthopaedic surgeries such as THA and TKA. Insight from the queried surgeons will help drive future research areas to address this need.

Specific depressive symptoms, body mass index and diabetes in middle-aged and older Chinese adults: Analysis of data from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

This study examined the association between specific depressive symptoms and incident diabetes, and whether overweight or obesity mediates this relationship among middle-aged and older adults in China.

METHODS

In a nationally representative prospective cohort study of 11,893 middle-aged and older Chinese adults without baseline diabetes, we used Cox models to assess the association between depressive symptoms and diabetes. The quantile g-computation (qgcomp) model evaluated the contribution of 10 specific depressive symptoms to diabetes risk, and a two-stage regression method explored the mediation effect of overweight or obesity.

RESULTS

Over a median follow-up of 7.1 years, 1,314 cases of diabetes were identified. Elevated depressive symptoms were associated with increased diabetes risk (HR 1.23; 95 % CI 1.09-1.38). Eight out of 10 depressive symptoms were significantly associated to diabetes, with loneliness (weight = 18 %; HR 1.23; 95 % CI 1.10-1.39), restless sleep (weight = 17 %; HR 1.16; 95 % CI 1.04-1.29), and bother (weight = 15 %; HR 1.19; 95 % CI 1.07-1.33) being the primary contributors. Mediation analysis showed that overweight and obesity reduced the depression-diabetes risk association by 8.21 % and 12.61 %, respectively.

LIMITATIONS

Diagnosis of diabetes was self-reported.

CONCLUSIONS

Eight out of ten specific depressive symptoms were associated to diabetes, overweight and obesity may partially mitigate the effect of depressive symptoms on diabetes among middle-aged and older adults in China.

CLINICAL IMPLICATIONS

Our results highlight the importance of tailoring diabetes prevention and management strategies according to specific depressive symptoms among middle-aged and older adults in China.

Binge eating disorder recognition and stigma among an adult community sample

BACKGROUND

Despite being the most prevalent eating disorder, Binge eating disorder (BED) remains largely unrecognized and lacks awareness among the general public, where it is also highly stigmatized. Common stigma surrounding BED includes the belief that individuals with this disorder are responsible for their condition and lack willpower and self-control. Research on BED recognition and stigma among lay adults is scarce. Enhancing public recognition of BED and reducing the stigma associated with it is crucial, as this could significantly improve access to treatment. The aim of the present study was to examine BED recognition and stigma within an adult community sample, and to identify associated respondent characteristics, including sociodemographic and psychosocial factors.

METHODS

A sample of 894 adults (88.6% women; Mage = 35.20 ± 14.52) completed an online survey. Participants were presented with a vignette depicting a woman with BED and obesity, followed by questionnaires assessing BED recognition, stigma, and other respondent characteristics. Independent samples t-tests were performed to compare participants who recognized BED in the vignette with those who did not, based on sociodemographic characteristics (i.e., gender, age, income, education) and psychosocial variables (i.e., explicit and internalized weight bias, familiarity with BED). A multiple linear regression analysis was performed to identify the sociodemographic and psychosocial variables that were the most important in explaining the variance in stigma towards BED.

RESULTS

Results indicated that 33% of participants identified BED as the main problem in the vignette. Those who recognized BED were younger, more educated, more familiar with BED, and exhibited lower levels of stigma towards BED. The most significant factor in explaining stigma towards BED was explicit weight bias, particularly attributing obesity to a lack of willpower and disliking people with obesity. Identifying as a man and older age were also associated with greater stigma towards BED.

CONCLUSION

The findings of the current study highlight the importance of comprehensive public awareness campaigns to improve recognition of BED and to reduce associated stigma.

Humor as a window into generative AI bias

A preregistered audit of 600 images by generative AI across 150 different prompts explores the link between humor and discrimination in consumer-facing AI solutions. When ChatGPT updates images to make them "funnier", the prevalence of stereotyped groups changes. While stereotyped groups for politically sensitive traits (i.e., race and gender) are less likely to be represented after making an image funnier, stereotyped groups for less politically sensitive traits (i.e., older, visually impaired, and people with high body weight groups) are more likely to be represented.

Differences in severity of depression symptoms in overweight, obese and normal weight Palestinian children and adolescents

Obesity is related to a wide variety of medical and psychological comorbidities which has short- and long-term effects on children's mental health. One of the most significant ones is depression. Thus, the current study utilized a descriptive methodology to explore the differences in depressive symptoms among overweight, obese, and normal-weight Palestinian children and adolescents. Data was collected from 270 Palestinian children and adolescents, aged (9-16) years: 85 with normal weight, 95 with over-weight and 90 obese. Findings showed that participants who are over-weight or obese exhibited more depressive symptoms than those with a normal weight. These findings showed that Palestinian children and adolescents who are over-weight or obese do experience depression and thus interventions should take this into account. In particular, it seems that over-weight boys or adolescents need more direct help in losing weight while obese children and adolescents who feel more helpless about their weight need serious psychological interventions. it is critical to offer psychological treatment as part of any weight loss intervention program for children and adolescents. Especially as these adolescents' families might encourage them to avoid seeking professional help and deal with the problem in the family.